Inner retinal dimples (IRD), occurring after full thickness macular hole (FTMH) repair, have been linked to intraoperative peeling of the internal limiting membrane (ILM). We performed a retrospective analysis of eyes that developed dimpling after FTMH repair to identify characteristics that may predict geographic extent or timing of “early” versus “late” dimpling.

Methods

Patients with surgical videos for FTMH surgery operated by a single surgeon (SC) with ILM peeling were retrospectively reviewed and divided into those who experienced “early” dimpling, ≤3 months of postoperative follow-up, and “late” dimpling, >3 months. Patients were also grouped by the geographic extent of the dimpling; termed “localized” if dimpling was noted in the temporal quadrant only, and “extensive” if it was present in both temporal and nasal quadrants. Univariate regression analysis was used to correlate baseline, intraoperative and postoperative characteristics with each of these two outcome variables.

Results

A consecutive series of 25 patients with IRD after FTMH repair between 2010 to 2013 were included in the study. Average length of follow up was 27.2+/-11.9 months and the average time by which the patients developed IRD was 4+/-3.5 months. All patients in our study with a preoperative history of glaucoma experienced IRD in ≤ 3 months. Additionally, despite low numbers of patients in our study, we found several factors to be significant at the 10% level. Patients with worse preoperative best corrected visual acuity (BCVA) were more likely to develop early IRD (p=0.091), and those with intraoperative diffuse brilliant blue staining pattern were more likely to develop late IRD (p=0.073). Female patients (p=0.029) and those with greater total volume (p=0.060) on spectral domain optical coherence tomography (SD-OCT) on the first postoperative OCT were more likely to develop localized IRD. There was also an association between a larger drop in logMAR BCVA and extensive IRD (p=0.068). No association was observed between preoperative macular hole size or number of intraocular hemorrhages during ILM peeling and the timing or geography of IRD.

Conclusions

Timing and location of IRD may be related to preoperative, intraoperative and postoperative characteristics. All patients in our study with a prior history of glaucoma developed IRD within 3 months, a finding that warrants further investigation.